Anterior Cruciate Ligament Reconstruction Rehabilitation

Background Identifying risk factors for inferior outcomes after ACL reconstruction (ACLR) is important for prognosis and future treatment. The goal of this study was to determine whether articular cartilage and meniscal variables are predictive of 3 validated sports outcome instruments after ACLR. Hypothesis/Purpose We hypothesized that articular cartilage lesions and meniscus tears/treatment would be predictors of the IKDC, KOOS (all 5 subscales), and Marx activity level at 6 years following ACLR. Study Design Prospective cohort, Level 1 Methods Between 2002 and 2004, 1512 ACLR subjects were prospectively enrolled and followed longitudinally with the IKDC, KOOS, and Marx activity score completed at entry, 2, and 6 years. A logistic regression model was built incorporating variables from patient demographics, surgical technique, articular cartilage injuries, and meniscus tears/treatment to determine the predictors (risk factors) of IKDC, KOOS, and Marx at 6 years. Results We completed a minimum follow-up on 86% (1307/1512) of our cohort at 6 years. The cohort was 56% male, had a median age of 23 years at the time of enrollment, with 76% reporting a non-contact injury mechanism. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC]-25%, lateral femoral condyle [LFC]-20%, medial tibial plateau [MTP]-6%, lateral tibial plateau [LTP]-12%, patella-20%, trochlear-9%) and meniscal (medial-38%, lateral-46%). Both articular cartilage lesions and meniscal tears were significant predictors of 6-year outcomes on IKDC and KOOS. Grade 3 or 4 articular cartilage lesions (excluding patella) significantly reduced IKDC and KOOS scores at 6 years. IKDC demonstrated worse outcomes with the presence of a grade 3-4 chondral lesion on the MFC, MTP, and LFC. Likewise, KOOS was negatively affected by cartilage injury. The sole significant predictor of reduced Marx activity was the presence of a grade 4 lesion on the MFC. Lateral meniscus repairs did not correlate with inferior results, but medial meniscus repairs predicted worse IKDC and KOOS scores. Lateral meniscus tears left alone significantly improved prognosis. Small partial meniscectomies (<33%) on the medial meniscus fared worse, but conversely, larger excisions (>50%) on either the medial or lateral menisci improved prognosis. Analogous to previous studies, other significant predictors of lower outcome scores were lower baseline scores, higher BMI, lower education level, smoking, and ACL revisions. Conclusions Both articular cartilage injury and meniscal tears/treatment at the time of ACLR were significant predictors of IKDC and KOOS scores 6 years following ACLR. Similarly, having a grade 4 MFC lesion significantly reduced a patient’s Marx activity level score at 6 years.

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“…8 Following surgery, each patient followed the same standardized evidence-based rehabilitation protocol. 44,45,46 …”

Section: Methodsmentioning

confidence: 99%

Are Articular Cartilage Lesions and Meniscus Tears Predictive of IKDC, KOOS, and Marx Activity Level Outcomes After Anterior Cruciate Ligament Reconstruction?

Cox¹,

Huston²,

Dunn³

et al. 2014

Am J Sports Med

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226

247

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“…Detailed post-operative ACL reconstruction rehabilitation protocols have previously been published elsewhere [5][6][7][8]. Specific details regarding exercises and timing is beyond the scope of this paper, and it is recommended to consult these references for additional content.…”

Section: Rehabilitation Protocolsmentioning

confidence: 99%

Prevention and Management of Post-operative Complications Following ACL Reconstruction

Eckenrode

Carey

Sennett

et al. 2017

Curr Rev Musculoskelet Med

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Purpose of Review The goal of this paper is to review the current management and prevention of post-operative complications after anterior cruciate ligament (ACL) reconstruction. Trends in rehabilitation techniques will be presented, in addition to suggestions for interventions and expected milestones in ACL reconstruction recovery. Recent Findings ACL reconstruction protocols have evolved to more of a criterion-based progression rather than a tissuehealing time frame. Given the evolution of ACL surgical reconstruction techniques and rehabilitation protocols, the risk of post-operative complications can arise both early and late in the recovery process. This paper will discuss the role of preventative measures as it applies to the post-operative patient with ACL reconstruction. Summary Short-term complications following ACL reconstruction include infection and deficits to knee motion and strength, whereas long-term complications include secondary ACL injury to either the involved or contralateral knee and lack of ability to return to high-level sports following this procedure. Future research should continue to address the multifactorial causes of secondary ACL injury and limited ability of patients to return to high level activities.

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“…29,49,50 Progression is based on both clinical milestones and healing time frames. Readers may consult these criterion-based rehabilitation programs 1,28 and the complimentary MOON guidelines 63 for general ACLR rehabilitation.…”

Section: Early Rehabilitation After Aclrmentioning

confidence: 99%

On-Ice Return-to-Hockey Progression After Anterior Cruciate Ligament Reconstruction

Capin¹,

Behrns²,

Thatcher³

et al. 2017

Journal of Orthopaedic & Sports Physical Therapy

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SYNOPSIS Limited literature exists pertaining to rehabilitation of ice hockey players seeking to return-to-sport after anterior cruciate ligament reconstruction (ACLR). The purpose of this clinical commentary is to present a criterion-based, return-to-ice hockey progression for athletes after ACLR. First, we review pertinent literature and provide previously published guidelines on general rehabilitation after ACLR. Then, we present a four-phase, on-ice skating progression with objective criteria to initiate each phase. During the early on-ice phase, the athlete is reintroduced to specific demands, including graded exposure to forward, backward, and crossover skating. In the intermediate on-ice phase, the emphasis shifts to developing power and introducing anticipated changes of direction within a controlled environment. During the late on-ice phase, the focus progresses to developing anaerobic endurance and introducing unanticipated changes of direction, but still without other players or contact. Finally, once objective return-to-sport criteria are met, non-contact team drills, outnumbered and even-numbered drills, practices, scrimmages, and games are progressively reintroduced during the return-to-sport phase. Recommendations for off-ice strength and conditioning exercises complement the on-ice progression. Additionally, we apply the return-to-hockey progression framework to a case report of a female collegiate defensive ice hockey player who returned to sport successfully after ACLR. This criterion-based return-to-hockey progression may guide rehabilitation specialists managing athletes returning to ice hockey after ACLR.

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Anterior Cruciate Ligament Reconstruction Rehabilitation

Cited by 168 publications

References 75 publications

Are Articular Cartilage Lesions and Meniscus Tears Predictive of IKDC, KOOS, and Marx Activity Level Outcomes After Anterior Cruciate Ligament Reconstruction?

Are Articular Cartilage Lesions and Meniscus Tears Predictive of IKDC, KOOS, and Marx Activity Level Outcomes After Anterior Cruciate Ligament Reconstruction?

Prevention and Management of Post-operative Complications Following ACL Reconstruction

On-Ice Return-to-Hockey Progression After Anterior Cruciate Ligament Reconstruction

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